View the Environment: Professional Staff vs Management Staff

In a healthcare environment, the professional, front-line staff members such as doctors and nurses are those staff members who interact directly with customers or the public, rather than with members of the organization. The latter is more typical of management. Although collaboration between nurses and doctors can itself be a problem, this is less likely to prove problematic than the relationship between professional staff members and management staff (Zwarenstein, 2000) Professional staff members, because they have extensive interaction with customers or the public, will invariably have a more patient-focused rather than cost-focused orientation than hospital management staff. Also, in contrast to management, there are stronger time and resource pressures on the front-line environment in an immediate and personal way, than in a holistic and long-term fashion. Professional staff members are technically focused on doing the job for the day and helping patients, rather than helping the hospital-the pressures of patient health provide a more immediate focus. Unlike management, the professional members of the staff have received a considerable amount of structured training as part of their previous, pre-organizational hands-on healthcare education. The hospital organization is legally liable for the actions of front-line staff, should mistakes regarding patient health be made, nor organizational business ‘health'-health care staff are health care professionals, not business people. (Robertson, 2003) There is little team-based or project-based work in the front-line professional health care environment. Instead, the front-line typically performs the work specified by their profession and the needs of patients, reflecting any changes and initiatives implemented by management only when instructed. (Robertson, 2003) Cost of supplies, for example may be a greater concern for management than care for professional staff, and professionals may have less of a tolerance for bureaucracy and paper work, although certain concerns, such as time management may be shared by both.

Campaign Threats or Implied Promise of Benefits

Did the employer statements constitute an unlawful threat or an unlawful promise in violation of Section 8(a)(1) of the LMRA? Why or why not? Yes, the employer statements were unlawful. The NLRA guaranteed workers the right to join unions without fear of management reprisal. It created the National Labor Relations Board (NLRB) to enforce this right and prohibited employers from committing unfair labor practices that might discourage organizing or prevent workers from negotiating a union contract. Employees shall have the right to self-organization, to form, join, or assist labor organizations, to bargain collectively through representatives of their own choosing, and to engage in other concerted activities for the purpose of collective bargaining or other mutual aid and protection. Section 8 defines employer unfair labor practices. Employer interference, restraint, or coercion directed against union or collective activity (Section 8(a)(1)), was violated in this case study. Threats, warnings, and orders to refrain from protected activities are forms of interference and coercion that violate Section 8(a)(1). Section 8 also prohibits union unfair labor practices, which include, according to legal construction, failure to provide fair representation to all members of the bargaining unit. The NLRA sets out general rights and obligation. Enforcing the Act in particular situations is the job of the NLRB. Did the questioning or statements by either supervisor Bates or Lofton constitute unlawful interrogation in violation of Section 8(a)(1) of the LMRA? Explain fully why or why not. As mentioned in the first question, yes it was unlawful interrogation. These supervisors were desperately trying to get the employees to vote against the union. In the event that they were successful at having all of their employees to vote against the union, some of them may have been unhappy and treated unfairly. Without representation, an employee will lose most battles against companies, unless they have solid proof of the employer’s wrongdoing. In the case I notice how the supervisors both told employees about the reduction in their benefits. They were trying to use scare tactics because they know people need their benefits. The supervisors seem to want to make these promising decisions when in fact they should have been offering these things to the employees in the first place. It doesn’t make sense to try to make things better to keep from getting the union involved. The plant manager was trying to convince the employees that they are able to handle things without the union getting involved. The manager tried to say that the unions are known for making broken promises, but it seems as if that is what the employer was doing. Develop a set of guidelines for supervisors and managers to follow when speaking to employees during a union organizing campaign. Employers should not threaten employees during an organizing campaign, but economic predictions regarding matters outside of the employer’s control, which are demonstrable, may be made. The employer should refrain from inflaming racial hatred. They should listen to what the employee has to say and advise them that they are able to speak with anyone on the management staff without union representation. They should advise the employees of the benefits that they are currently enjoying; however there is no need to make a threat to take away any benefits or reduce the cost. In the event that an employee is being insubordinate, they will need to continue to follow company’s policies and guidelines; however they will need to make sure they have sufficient evidence to support their decision. The NLRB prohibits employers from holding captive audience meetings 24 hours prior to the election, because insufficient time will exist for the union to respond; therefore if they decide to hold a meeting it will have to be within reasonable times. There should be a social media policy in place and such policy should be clear and understandable to the average employee. The NLRB’s rulings have in large part turned on the ambiguities of social media policies, and the possibility that employees may misunderstand the policies to bar protected activities. A social media policy must not be overbroad. Policies should be narrowly drawn to address the employer’s legitimate policy objectives (for example, preventing the disclosure of the company’s proprietary information via social media or restricting the use of social media to engage in harassing conduct that would violate the company’s anti-discrimination and harassment policies). Employers will not like what the unions are trying to do, but this does not give them the right to talk down on the unions. When employers talk to employees during a union organizing campaign, they will need to be mindful of what they are saying. Sometimes people talk too much and a supervisor or manager could cause an employer to have a lawsuit. Within the guidelines, I suggest the managers and supervisors to keep their negative thoughts to themselves. This will eliminate someone saying the wrong thing and will allow the employees to make a valid decision based on their own thoughts and opinions. Explain fully how the NLRB should rule in this case and why. The NLRB should rule that the employer is in violation because of the things the supervisors said. This may not be the first time or maybe it is; however it should not go unnoticed and that is what some would like to see. In this case, the employees are being threatened about their benefits and wages. They are also making it seem as if they don’t need a union, when in fact they seem to really need someone there to represent the employees. The company also threatened two of the union supporters. When the supervisor advised that if they strike, there are more people waiting for their jobs; apparently that supervisor is not aware of the employee rights with the union behind them. The employer has to hold their jobs when they go on strike.

Religious Studies Essay Example | Topics and Well Written Essays - 1000 words

Religious Studies - Essay Example Religious Definition by Steve Bruce: In his book â€Å"God is Dead: Secularization in the West†, 2002, Steve Bruce defines religion as â€Å" beliefs, actions and institutions predicated on the existence of entities with power of agency (that is gods) or impersonal powers or processes possessed of moral purpose (the Hindu notion of Karma), which can set the conditions of, or intervene in human affairs†. Comparison of the Definitions: My definition starts with the element of sharing, whereas in the definition of Steve Bruce there is no element of sharing. From the perspective of individuality and extreme secularization the element of sharing in my definition is a weakness. It makes it necessary that religion is not individualistic, but a shared activity of a group. From my perspective I do not find this a weakness. Social living is an essential part of human existence. Social interaction and society developed from sharing of common factors that bound a group of humans together, which included religion. With time, in more advanced societies tolerance of members with belief in other religions became a norm and so no longer was it necessary that all members of a society or community shared the same religion. Still religion is shared and is not an individualistic belief and action, as even Steve Bruce makes institutions a necessary part of religion. In my definition religion needs to answer the purpose of existence and having served this purpose to the satisfaction of the almighty, what happens after death.

Marine Organisation Essay Example | Topics and Well Written Essays - 2250 words

Marine Organisation - Essay Example Thus the situation today is not the same as the situation that was present a few earlier. The first step in the exercise is to determine what are marine operations and this can be given as the planning and execution of specific requirements for different purposes within marine areas for transferring of loads, towing of vessels, transports of special items through the seas, servicing of installations which are fixed with the sea and are referred to as off-shore installations, lifting of all types of material from within the sea and from the sea bed, operations which are carried out below the level of the seas and transit and positioning of mobile offshore units. (DNV Rules for Planning and Execution of Marine Operations) During the cases when the marine operations are important for the purpose of battle, one of the most important aspects are to ensure the supplies for the soldiers involved in the war, as was observed to be the case in Vietnam. (Humphries, 1999, p. 223) While the general feeling is that services of marines are restricted to operations on the sea, there are occasions when they are used on land. These also lead to unfortunate incidents as was the case in Haiti, which was occupied by a marine detachment, and on occasions they were even rushed by angry peasants armed with stones, machetes and clubs. (Schmidt, 1998, p.205) In the earlier years, there were different purposes for marine operations, and they were mainly conducted by the navies of the countries, whereas today, the efforts are to use marine forces which are a cross breed between the navy and the army. Their main function is anti-terrorism which involves taking action to reduce the vulnerability of individuals and property to attacks by terrorists. (Pushies, 2003, p. 34) The definition of marine operations is itself a little complex and certain matters have to be comprehended and fishing is a marine operation as it involves collection of fishes from within the sea. Carrying of goods in both tankers and large cargo vessels come within the limits of load transfer operations. All maritime places of work are also treated as a workplace under the laws of most countries, but all of them have different laws which are applicable in the case of accidents which take place during the process of work. (Occupational Health and Safety Programs) This makes it compulsory for the workers to be treated in the case of unfortunate events as per the laws of the country where the ship is registered as ships are considered to be a part of the country. This is the reason why most ships of different countries, meaning those with owners in other countries are still registered under some "flags of convenience" like Panama, Liberia, etc. The attempt is to avoid payment of high liabilities. At the same time, after the incident, the vessel will reach another port, and the country where it reaches is also permitted to ensure that workers on the ship receive "minimum human treatment". (Darling unveils Marine Environmental High Risk Areas) There are cases where ships have been auctioned off to pay the dues to the country and the workers on the ship. On the other side, when the ship reaches a port, the port is also a marine installation and this is covered

Spirituality in Therapy Essay Example | Topics and Well Written Essays - 1000 words

Spirituality in Therapy - Essay Example Through the years, Psychoanalytic Therapy has evolved dramatically, seeking more effective ways to bring reconstruction to patients from personality conflicts. Among these is Humanistic Therapy which sees the patient as a human being with an innate positive drive for a better life. Dolto and Olthuis adopt humanistic therapy with the addition of Christian spirituality concepts which this paper attempts to discuss. As practicing Christian, Francoise Dolto brought ideas from Christianity into her clinical practice. Dolto was influenced by the Humanism of French psychoanalyst Jacques Lacan, who stressed the need for psychologists to recognize the religious depths of personality in the human person. Adopting Lacan’s insights on the religious personality, Dolto gave importance to the spiritual-psychological dialectic of the â€Å"I† and the â€Å"me† of the human person (Slattery,2002). Beyond Lacan, however, Dolto focused more on the spiritual dialectic with the clien t finding joy and desire to strive for meaning in his life through Gospel truths. In her clinical practice, Dolto worked along an ethics of desire for a loving relationship in the patient. Her therapeutic process consisted in freeing an innate frozen human desire—structured by the Creator-- to rise up towards relational cohesion with all created beings. During the spiritual dialectic, Dolto the therapist helped the patient to project this innate desire onto others consonant with a capacity to love. For Dolto, the Gospel can be instrumental to this spiritual dialectic since it is the seat of Christ’s teachings on compassionate love and openness to others, exemplified by Jesus’ story about the Good Samaritan. Dolto believes that if compassionate love fills the world, man can free its innate desire for the cohesion of all of humankind. Meanwhile, James Olthuis in his writings harps on a Christian way of therapy through a relational dialectic between therapist and c lient. Understandably reflective of his career as a philosophical theologian, Olthuis chose Christian Love as the basic theme of his book the Beautiful Risk (Oltuis, 2001). His actual therapeutic methodology is scientific and objective, since he as an analyst related to his clients with clinical skills, but at the same time he filled himself with sensitivity and honesty sourced from Christian compassion. Through the dimension of his Christian faith, Olthuis has enriched the humanist’s view of self-actualization mediated by Christian care, connection, partnership and love. Impact of spirituality in therapy Given the relational spiritual dialectic of Dolto, my therapeutic practice can gain a deeper dimension by including God in my therapy work. To reflect on my education, I was taught therapeutic practice mainly along scientific concepts and procedures. Faith is understandably not within the purview of psychological education and training. I have even observed, for example, tha t clinicians remove from patients all items of faith like crucifixes, rosaries and prayer books prior to treatment or confinement. Dolto, however, makes a radical move as she showed that the path to cure is a deeper dialectic, the spiritual one encompassing the scientific efforts in helping a patient. Complementing this is Olthuis’ idea of professional practice that is imbued with Christian care, connection, partnership and love. Given Dolto’s and Olthuis’ religious perspectives, I believe I can now see my patients in a new light, specifically as seekers of meaning and cohesion within themselves and harmony with life. On their part, clients will see freedom at the end of the tunnel of their entrapment with complex biological, psychic and social forces that complicate their lives. As a therapist, I am both a

Project proposal Essay Example | Topics and Well Written Essays - 1000 words

Project proposal - Essay Example â€Å"In the hospitality field, not only are business transactions of the utmost importance, but so are concerns for public health and safety.† Due to the importance of practicing hospitality ethics, teaching of ethic philosophies should start right from the school. Even if philosophical lectures alone will not make students virtuous, however, they can help them think more clearly about day-to-day ethical problems with which they will be confronted in their future careers as ethical challenges remain a daily occurrence in the hospitality industry â€Å"The hospitality industry offers many examples of situations that can damage individual integrity and responsibility. One instance would be a manager's willingness to continue daily operations and preserve his job even as the resort is polluting the local environment.† Ethics should therefore extend beyond the hotel building to include the welfare of the society. â€Å"By focusing on you, your business, your products and services, your prices and your delivery, you can overcome the status quo and that is just plain good and ethical business practices.† To this end, business managers such as hotel managers should make hospitality ethics an all-inclusive concept that caters for areas such as prices, service delivery and manners. Research Rationale The way of doing business all over the world is fast changing. This change is seen more especially in the way businesses attract customers. Years past, competition in the hospitality industry for customers used to focus on who had the best facility and products. Today, the means of attracting customers seem to center more on marketing than product. As far as the hospitality industry is concerned, one of the best ways to market a business like a hotel is to embark on the massive application of hospitality ethics. Perhaps the reason why hospitality ethics seem to be receiving so much attention among customers in the hospitality industry is that ethics ar e founded based on human philosophies and theories. According to the World Lingo, â€Å"Hospitality theories and norms are derived through a critical analysis of hospitality practices, processes, and relationships; in various cultures and traditions; and throughout history. Ultimately, hospitality theories are applied, and put to practice in commercial and non-commercial settings.† This is to say that practicing simple ethics is so important to the customer that, the little gestures shown to him, can make him come back to the hotel – a real marketing strategy. Unlike before, the customer is now very conscious about how he is treated in which hotel. It is therefore not surprising that some customers select certain hotels even when they have the same facilities as other hotels and yet have expensive prices. This research seeks to examine the power of hospitality ethics on e customers of world class hotels. As a relation, there shall be critical analysis to find out if th e practice of hospitality ethics itself even has the power to raising a hotel to a world class status. This is research is achievable and because of the several avenues available to the researcher to access information from hotel users. There are also several theories that will guide the researcher in

Coca Cola Company Essay Example | Topics and Well Written Essays - 1000 words

Coca Cola Company - Essay Example Many consequences arose as a result of this move. The first consequence and a positive one is the fact that people accepted the move because they saw it as a way of environmental conservation. The negative consequences are seen it terms of the confusion it created. People could not differentiate the diet coke from the regular coke. Secondly, people were loyal to the red can and therefore changing to white was like playing with their minds and this made it difficult for them to even buy the drink (abc). The case of coca cola confirms the view that people buy products to satisfy their need. They attach a certain meaning to a give product and develop a relationship with the brand. They therefore become loyal to the brand and changing any aspect of it may anger consumers and the consequences may be dire for a company. People identify with their brands and in so doing develop a relationship with the brand to the extent that their beliefs and attitudes towards the product become permanent. A slight change becomes costly to the company (Helm). As discussed above, consumers often build relationships with products over time. These relationships are as a result of the beliefs and attitudes that they hold about a particular product or service. These attitudes and beliefs shape their perceptions about the product and its perceived value. The perceived value the customers attach to a product is as a result of the benefits that they get as a result of using the product. The product may perform relatively high above the performance of other competitive products or it may offer better service to them or even it may be of superior quality than competitive products. The difference may be small but this generates customer loyalty to the product and thus subsequent purchase of the product is guaranteed (Mullins and Walker 13-16). Product perception can be defined as the individual’s mental impression of a stimulus object in this case a product. People have different percept ions about products and no two people think alike about the same product. Perception is selective, is organized, and depends on personal and stimulus factors (Helm). It is important that companies build a brand and work on maintaining the brand and its associated images and product designs. A change in this creates conflict within the customer’s minds altering their beliefs and attitudes towards the product (Mullins and Walker 18). Some customers take time to adjust to the change will others fear change and therefore prefer to stick with what they know about their product. This was the case for Coca Cola and the white cans. The introduction of the white cans violated the expectations of the consumers and thus creating the confusion and this led to subsequent rejection of the white cans. This process of rejection of the white cans can be explained by the cognitive dissonance theory. According to this theory, there is always a tendency for individuals to seek consistency among their cognitions that is their beliefs, opinions, attitudes etc. when there is an inconsistency between the attitudes or behaviors often referred to as dissonance, then something must change to eliminate the dissonance. In the case of a discrepancy between attitudes and behavior, it is most likely that the attitude will change to accommodate the behavior (Blythe 161-162). Two factors affect the

How Employee Motivation Enhances the Organisational Performance Assignment

How Employee Motivation Enhances the Organisational Performance - Assignment Example The researcher states that one of the earliest studies on employee engagement was the research study footed upon three years of research work by officials at Roebuck and Co & Sears thereby reconstructing the company around its clients. The resulting service which was a profit chain replica was footed upon then freshly developed evaluation mechanisms and found that â€Å"there exists a chain of cause end impact starting from the employee demeanor to the customer demeanor to revenues. As per recent research, a satisfaction of the customers and the resulting financial benefits from recurrence, loyal business emerges from emotional engagement within an employee-customer collaboration. Moreover, businesses that show more emphasis on high-performance and excellence will travel beyond employee engagement to employee entanglement. Entanglement is the critical element that distinct world-class from ordinary performance, offering an organizational capability that makes front-runners among pee rs. General Electric (GE) has posted more than $146,045 m. in 2013 and $146,684 m. in 2012 as revenues, and it is making the substantial investment on the yearly basis in developing its global workforce. It employs about 135,000 persons in the USA and 172,000 persons outside the USA in 2013. GE offers a broad range of career advancement’s chances to its employees, it encourages its employees to acquire through formal learning and development educational courses and offers many means to accomplish a balance between professional and balance objectives. GE offers an environment for their employees to exercise their accountability, integrity, and creativity while developing themselves and their careers. A new employee who joined GE will be given an opportunity to be trained at various divisions to sharpen their experience and skills. Every year, GE earmarks huge sums for imparting training programs, a notable commitment to investing in the educating and motivation of its employee s. Newly recruited managers will have to attend a mixture of classroom seminars and will be provided with work assignments on a rotational basis.

Common Sense by Thomas Paine Essay Example | Topics and Well Written Essays - 750 words

Common Sense by Thomas Paine - Essay Example Still, he helped in reforming the British Reform Act and brought liberty to France. In brief, Common sense is a booklet that advocated an instant declaration of the independence, which in turn would postulate a moral obligation to the Americans and the rest of the world. The writing sparked the American Revolution with its great insights that campaigned on freedom and liberty. The pamphlet challenged the leadership of British Government and its Royal monarchy by openly asking for independence. To date, his documentation inspires many as he presented great ideas of how mankind was originally created to be equal and thus, challenged the British Government that the equality could not be destroyed. The booklet â€Å" Common Sense† has been the most influential tract towards American Revolution ever published in English. The main idea was to encourage the colonists to reinforce their resolve to birth the most successful anti-colonial decision of the modern history. Paine’s W ork represents one or more defining American Characteristics as his arguments enhance significance in the â€Å"American Declaration of Independence.† Paine’s writings created a strong ground to the movement that had seldom worked out in past decades. The writing impacted strongly on the sovereignty of people and printed constitutions, which he declared his interests on freedom, liberty, and equality for all people. Still, he insisted on effective checks along with balances in the government as he thought this would transform the economy and better standards of living. In his writting, he inspired many with great thoughts of defining the American characteristics as discussed. In my opinion, this book has resonated with so many different societies and people over the past decades because it presents great thoughts that regard freedom, liberty, and equality. Many identify themselves with Paine’s ideas that mostly majored on defining human characteristics. In other words, his emphasize was to bring a concept that would transform the world with common sense on the need for freedom. To gain a clear understanding, he outlines how the society by its nature is a blessing but regard government in its best state as evil. Paine affirms that the British government destroyed innocent lives thus it was unanswerable to defy human rights. Following this, the writer advocated for an immediate declaration of independence that would regard the rights of people. Therefore, the booklet becomes the leaven for the past decades as it presents great thoughts of freedom, liberty, and equality that most societies and people find it helpful. In his writting, Paine talks at length about monarchy in general and how the British Monarchy was holding back American’s potential. He was successful into bringing the political debate that the British Government merit the attention of other countries with their own governments to form. He captures readers’ attenti on by successfully persuading them that his ideas simply common sense when he relates his ideas in the scripture that disregard the monarchy government as one of the Jews’ sins. He continues to assert that in every instance the monarchy is popery to the government but not to the ordinary citizens. In this regard, he was successful into bring the concept of monarchy into a real political debate by relating it with biblical doctrines that viewed monarchy as evil. Therefore,

Nonprofit Sports Marketing Plan Assignment Example | Topics and Well Written Essays - 4500 words

Nonprofit Sports Marketing Plan - Assignment Example It is evidently clear from the discussion that UBA will be operating mainly for the population of Saipan. However, it plans to continue on its success, of organizing inter-Island tournaments. The main target market will be students of public schools who do not get enough opportunities to play high-quality Basketball. UBA plans to build a reputation and differentiate itself from its customer on the basis of its officials and referees. The capital expenditure is nonexistent for UBA thus risk associated with UBA will be very low. With dedication and expertise, UBA will grow into a nonprofit brand which is the symbol of Basketball in Saipan. With the advent of consumerism, a phenomenon not new to the human race has surfaced once again. As a result of capitalism, we live in a society which doesn’t give equal opportunities to everyone; some of our brightest talents are wasted because of a lack of opportunities. Thus the need arises for organizations which would compensate for this i nequality by providing free services to the young minds of tomorrow. Ventures such as these are not only an act of philanthropy, bringing our society together in an act of charity but also entrepreneurial in nature. They create jobs thus reduce unemployment and add to the GDP. Team sports are the basic tool in the upbringing of any child. They instill the basic sense of loyalty that is necessary to a tribal being such as humans. They provide the basic training in how to live in a society, how to belong to something else outside your own personality and a home. This is a feeling which later develops into nationalism and humanity. A very famous team sport is Basketball. With millions of diehard fans in America now the game is expanding fast to other nations of the world. Recently it became part of the Olympics as well. Basketball requires the players to display accuracy, strength, agility, and guile for success.

Microsoft Office and Table Essay Example for Free

Microsoft Office and Table Essay You can restart the footnote numbering on each page or in each section. You can restart the endnote numbering in each section. Note If the footnotes in your document are numbered incorrectly, your document may contain tracked changes. Accept the tracked changes so that Word will correctly number the footnotes and endnotes. 1. On the References tab, click the Footnote Endnote Dialog Box Launcher. Show All Hide All You create a table of contents by choosing the heading styles — for example, Heading 1, Heading 2, and Heading 3 — that you want to include in the table of contents. Microsoft Office Word searches for headings that match the style that you chose, formats and indents the entry text according to the heading style, and then inserts the table of contents into the document. Microsoft Office Word 2007 provides a gallery with multiple table of contents styles to choose from. Mark the table of contents entries, and then click the table of contents style that you want from the gallery of options. Office Word 2007 automatically creates the table of contents from the headings that you marked. What do you want to do? Mark entries for a table of contents Create a table of contents Delete a table of contents Mark entries for a table of contents The easiest way to create a table of contents is to use the built-in heading styles (heading style: Formatting applied to a heading. Microsoft Word has nine different built-in styles: Heading 1 through Heading 9.). You can also create a table of contents that is based on the custom styles that you have applied. Or you can assign the table of contents levels to individual text entries. Mark entries by using built-in heading styles 1. Select the heading to which you want to apply a heading style. 2. On the Home tab, in the Styles group, click the style that you want. For example, if you selected text that you want to style as a main heading, click the style called Heading 1 in the Quick Style gallery. Notes * If you dont see the style that you want, click the arrow to expand the Quick Style gallery. * If the style that you want does not appear in the Quick Style gallery, press CTRL+SHIFT+S to open the Apply Styles task pane. Under Style Name, click the style that you want. Mark individual text entries If you want the table of contents to include text that is not formatted as a heading, you can use this procedure to mark individual text entries. 1. Select the text that you want to include in your table of contents. 2. On the References tab, in the Table of Contents group, click Add Text. 3. Click the level that you want to label your selection, such as Level 1 for a main level display in the table of contents. 4. Repeat steps 1 through 3 until you have labeled all of the text that you want to appear in the table of contents. Top of Page Create a table of contents After you mark the entries for your table of contents, you are ready to build it. Create a table of contents from built-in heading styles Use this procedure if you created a document by using heading styles. 1. Click where you want to insert the table of contents, usually at the beginning of a document. 2. On the References tab, in the Table of Contents group, click Table of Contents, and then click the table of contents style that you want. Note For more options, click Insert Table of Contents to open the Table of Contents dialog box. Create a table of contents from custom styles that you applied Use this procedure if you already applied custom styles to your headings. You can choose the style settings that you want Word to use when it builds the table of contents. 1. Click where you want to insert the table of contents. 2. On the References tab, in the Table of Contents group, click Table of Contents, and then click Insert Table of Contents. 3. Click Options. 4. Under Available styles, find the style that you applied to the headings in your document. 5. Under TOC level, next to the style name, type a number from 1 to 9 to indicate the level that you want the heading style to represent. Note If you want to use only custom styles, delete the TOC level numbers for the built-in styles, such as Heading 1. 6. Repeat step 4 and step 5 for each heading style that you want to include in the table of contents. 7. Click OK. 8. Choose a table of contents to fit the document type: * Printed document If you are creating a document that readers will read on a printed page, create a table of contents in which each entry lists both the heading and the page number where the heading appears

Observations to Identify Child Needs

Observations to Identify Child Needs Planning, observation and assessment all contribute to supporting the learning and development of children. Careful observation can identify a child’s individual needs and interests and ensure that resources and activities are suitable for promoting further development. The early years recommends that practitioners follow a three-step cycle to effectively meet the needs of individual children. Planning Observation and Assessment. Write only what you see-this ensures accuracy. Write the date and time you’re observing, name and age of child, setting where the observation is being done. Avoid opinions, don’t say that the child is/ is not enjoying something, if they have not told you that. Continue with regular observations-this provides an overall consistent picture of the child’s development, and identify any areas of a child’s development that might need additional support or be delayed. You can learn a lot about the children you are working with by observing them, and you are more likely to be able to meet their individual needs effectively from observation. Formal observations can be used to observe a child’s development of a particular skill or knowledge and understanding. The practitioner can use adult-led activities to provide an opportunity for the child to practice this particular skill and observe their participation. Observations which are spontaneous, help gather information as children will be able to explore naturally without any added pressure. Formal observations can be used to observe a child’s development of a particular skill or knowledge and understanding. This is especially useful for development checklist for the child. There are factors to consider when observing a child and that it is regularly collected to produce a true picture of the child’s knowledge and abilities and ensure consistency in the evidence you collect. Many things can affect the validity of observation; tired or hungry or hungry children may not demonstrate skills to the best of their ability and might get different results in completing an observation on a child at different times of the day, illness can affect the child’s demonstrating skill if they are ill, or might not want to partake so won’t be demonstrating their true abilities. Practitioners should schedule a repeat observation whe n the child is well to gather the true picture of the child’s ability. It is important to see when a child has achieved a particular skill when you carried out the observations at the same time accurate results and consistency. There are many methods of observing and recording observations. Practitioners in early year settings often use a note taking method carrying with them a note pad, to write spontaneous occurrences in what a child’s interests and achievements are when they are engaged in an activity with them. This way of taking notes can then be written up after the events in more detail. Time sample is another way of recording information; this is a way of looking at a child’s activity over a period of time, observing the child at regular intervals for example every ten minutes for one hour. A summative assessment is when the evidence is gained through a formative assessment over a period of time and these are helpful when the practitioner needs to review a child’s developing progress. A formative assessment is an on-going assessment of the child, and carried out on a regular basis. The early years requires two formal summative assessments, at aged two and at the end of completion of the Early Year setting. Assessments after observations are the way in which the practitioner can make decisions about what the child can do. For example a practitioner is observing a child and note the child has spent ten minutes building bricks. It shows the practitioner that the child appears happily content doing this activity, it also shows the child can concentrate for a period of time and play independently. They are able to observe if the child is using favourably their left hand or right hand and their eye- to hand coordination is well developed.The practitioner can say if the child had any facial expressions i.e. smiling or frowning whilst doing the activity to show enjoyment or concentration. An observation like this helps the practitioner plan future activities well suited to the child to meet individual needs and abilities of the child, and encourage future development adding other construction activities for the child to try if naturally this is where the child is getting enjoyment. Planning for a child to help their development in their not as strong areas is very important also. And from observations you can assess where the child needs extra encouragement or additional help in certain areas, for example when a group of children asked to put their coats on ready to go outside. You can observe the children who are very capable of doing the task without aid and the children who take longer and need extra time or help. You can plan for this by dividing the children into two groups; group 1 and group 2. Group 1 being the slower children less able to p ut on their coats are to start getting ready first with extra time allocated than group 2.Planning should be built upon the observation and assessment findings of individual children in order to identify the best steps to take to further their learnings and development. The Early Years development matters document suggests that planning should include looking at what is next for the child including: experiences and opportunities, the learning environment, resources, routines and the practitioners’ role. A carer can observe an individual child during outdoor play and recognise that the individual child aged two years is climbing confidently and is beginning to pull themselves up on nursery play climbing equipment outdoors. So the carer can help the individual child by talking to the child about their movements and help them to explore new ways of moving, such as squirming slithering and twisting along the ground like a snake, and moving quickly, slowly or on tiptoe. Plan opportunities for children to tackle a range of levels and surfaces including flat and hilly ground, grass, pebbles, smooth floors and carpets. Provide a range of large play equipment both indoors and outdoors that can be used in different ways such as boxes, ladders –frames and barrels. Provide safe spaces and explain safety to the child and parents. These will help encourage their physical development even further. The Statutory assessments focus on three prime areas of development ages two and three progress check. The assessment review and identify the child’s strengths and any areas of where the child’s progress is less than expected. The progress check helps identify the child’s natural interests and plan effectively for the individual child. It is a good idea to show the parents how to understand effectively to support the child’s learning which can be encouraged at the home environment for the child. The assessment it helps identify any additional special educational need or identify any disability. The practitioners should develop a targeted plan to support the child’s future learning and development involving the parents and careers and other professionals which may be needed. The report shows reflecting development levels and needs of the child, it shows the areas where the child is progressing well, the areas where additional support may be needed, and focus particularly on where there is a concern that the individual child may have developmental delay, which may indicate a special educational need or disability. It must include any activities and strategies the provider must intend to adopt and address any issues or concerns. Parents must receive a written record of each of the child’s prime areas of development. It is of interest to the individual child to encourage the parents to share the information from the progress check with other relevant professionals, including their health visitor and the staff of any new provision the child may transfer to. The progress check and the Healthy Child Programme health and development review at age two, when the Health visitor gathers information on a child’s health and development, allowing them to identify any developmental delay and any particular support from which they think the child and family might benefit, should inform each other and support integrated work together. This also helps health and education professionals to identify any strengths as well as any developmental delay. The providers must have parental consent and careers to share information directly with other relevant professionals. The assessment at the end of early years foundation stage profile must be completed when the individual reaches age five in the final term no later than June 30 in that term. It provides a well-rounded picture of a child’s knowledge, understanding and abilities, their progress against expected levels and their readiness for starting year 1. It provides information to the parents, careers practitioners and teachers; the profile reflects ongoing observations, all the relevant records held by the setting, discussions with parents and careers and any other adult professionals relevant. The child’s development must be assessed against the Early learning goals, practitioners indicate whether children are meeting expected levels of development, or if they are exceeding expected levels and if not yet reaching expected levels. Year 1 teachers are given the Profile; this will help the teacher acknowledge the child’s stage of development and learning needs and help assist w ith the planning of activities. The Profile must be completed for all children, including with special educational needs or disabilities, with reasonable adjustments to the assessment process for children with special educational needs and disabilities are made appropriately. It is important to know that all children will have differing level of skills and abilities across the profile and it is important that there is a full assessment of all the areas of the child’s development to form plans for future activities and to help identify any additional support. Schools must share the results of the Profile with the parents and careers. The profile must be completed for all children, including of those with special educational needs or disabilities. Adjustments to the assessment process for the children with special educational needs and disabilities must be made as appropriate. Children will have differing levels of skill and abilities across the profile and it is important that there is a full assessment of all areas of their development to inform any future activities and to identify any additional support needs.

The Laugh Of The Medusa Cultural Studies Essay

The Laugh Of The Medusa Cultural Studies Essay The main reason for choosing the above critics and their respective essays is that within feminist theories, Cixous often comes to be associated with French feminist psychoanalytic theorists like Julia Kristeva and Luce Irigaray. In addition both critical essays are concerned with writing the body. By the early eighties, feminists had advanced to a confrontational attack on male supremacy, advocating a complete overthrow of the biased (male) canon of literature. French feminists, like Helene Cixous and Luce Irigary claimed that women should have a greater consciousness of their bodies when writing, a thing which would create a more honest and appropriate style of openness, fragmentation and non-linearity. Both feminist critics seem to have similar agendas mixing radical analysis with Lacanian and Freudian theory in order to deconstruct patriarchal hegemony in the connected real, symbolic and imaginary orders. Hence their unorthodox prose, a reaction against and within a symbolic order complicit in domination. Cixous first reading of the essay The Laugh of the Medusa reveals like an impassioned call to action and a feminist manifesto in which women are urged à ¢Ã¢â€š ¬Ã… ¾to write themselves out of the world men constructed for women. Using the first person, plural and imperative statements, Cixous urges women to put themselves the unthinkable/unthought into words (Putnam Tong, 1998). She pledges for the invention of a new insurgent writing that will allow women to deconstruct the discourse that regulates the phallocentric system. Therefore the purpose of the essay under analysis is to break up and destroy a type of men writing which has functioned as an instrument of patriarchal expression and which has become a locus where the repression of women has been for too long perpetuated. In the same line of thought, Irigary pledges in her essay This Sex Which Is Not One (1977) for promoting womens language which is viewed as far richer than mens language in that it does not follow only one thread. It is advanced the idea that womens writing is capable of constantly creating the other meaning (Irigary: 204) generating an incomprehensible multiplicity of meanings which are unable to remain immobilized, and therefore impossible to be included into patterns of sexuality and behavior imposed by the dominant patriarchal cultural and social norms. Writing and language become the main concepts of the essays under analysis and the centers around which all the other notions like feminine/masculine sexuality, identity, ideologies and power revolve. The concept of writing, most often hereafter referred to as à ©criture feminine is perceived as one important transformational tool if one is concerned with changing the social, cultural and political masculine economy. It is impardonable, as Cixous puts it that there has not yet been any writing that inscribes feminity (Cixous: 2042). Assuming that language is not a neutral medium it follows that writing is constituted in a discourse of relations social, political, and linguistic, and these relations are characterized in a masculine or feminine à ¢Ã¢â€š ¬Ã… ¾economy. In this model, patterns of linearity and exclusion (patriarchal logic) require a strict hierarchical organization of (sexual) difference in discourse and give a grossly exaggerated view of the sexual opposition actually inherent to language. Sexual opposition has always been inclusive to writing and is thus incriminated, this being one reason for women never having the possibility to speak as writing has always favored men, it worked for mans profit to the point of reducing writing to his laws (Cixous: 2050). Irigarys critical vision is therefore in agreement with Cixous ideas in that both point in negative terms to womens underdeveloped condition which stems from their submission to an oppressive culture. To this oppression, the feminist critics oppose a type of consciousness raising appeal as the main political base which would presumably be able to counteract the so-called amputation of power (Irigary: 205). Also a re-vision of the previous historical and cultural activity is needed backed by the critical force of feminist tradition. Therefore the rupture from the phallocentric tradition is indispensable as a means of escape for women. Like male sexuality, masculine writing, which Cixous usually termed phallogocentric writing, is also ultimately boring and furthermore stamped with the official seal of social approval, masculine writing is too weighted down to move or change. Womens writing expressed a unique female consciousness, which was more discursive and conjunctive than the male one. Such consciousness was completely different, and had been unfavorably treated. Simone de Beauvoir in The Second Sex studied the ways in which legislators, priests, philosophers, writers and scientists have striven to show that the subordinate position of women is willed in heaven and advantageous on earth. Women had been induced the idea of inferiority and, although men theoretically supported equality, they would object its implementation. Cixous essay in an attempt to define à ©criture feminine which favors experience over language and a type of non-linear, cyclical flow, actually lists one condition as the main prerequisite for bringing about some mutations in human relations: to destroy the sexual oppositions, as well as the distinction between feminine/masculine writing (Cixous: 2046). Such thread which aims at destroying the artificial power and cultural constructs is also favored by Irigary who militates against the type of thinking based on sexism and disjunctive political discourses: the power of slaves (Irigary: 205) would eventually collapse the binary thought inherent to Western tradition and would undo the logocentric ideology and proclaim woman as the source of life, power and energy. In doing this, one would necessarily destroy the phallocratic ideology which has been responsible for the symbolic annihilation of women (Tuchman, 1978). This annihilation serves to confirm that the roles of wife, mother and housewife, etc., are the fate of women in a patriarchal society. Women have been socialized into performing these roles by cultural representations that attempt to make them appear to be the natural prerogative of women. Furthermore, within the context of mass media, men and women have been represented in conformity with the cultural stereotypes that serve to reproduce traditional sex roles. Thus men are usually shown as being dominant, active, aggressive and authoritative, performing a variety of important and varied roles that often requires professionalism, efficiency, rationality and strength to be carried out successfully. Women by contrast are usually shown as being subordinate, passive, submissive and marginal, performing a limited number of secondary and uninteresting tasks confined to their sexuality, their emotions and their domesticity. The concern being voiced here is that this symbolic annihilation of women means that women, their lives and their interests are not being accurately reflected. Therefore, to Cixous, the practice of à ©criture fà ©minine is part of an ongoing concern with exclusion, with the transformation of subjectivity, and the struggle for identity. Moreover women in Western thought has represented the Other that can confirm mans identity as Self, as rational thinking being (Beauvoir, 1949). The concept of Self, she writes, can be produced only in opposition to that of not-self, so that the category of the Other is as primordial as consciousness itself. To constitute himself as Subject, man has constructed woman as Other: she is the incidental, the inessential as opposed to him, the Subject. Cixous voice acquires vehement tonalities militating for womens inscribing in language in a new articulation of feminine drives, libido and sex insinuating into texts as a means of liberation from their repressed sexuality and also as a means to changing the meaning of history: à ¢Ã¢â€š ¬Ã… ¾Let the priests tremble, were going to show them our sexts (Cixous: 2048). Écriture fà ©minine could certainly prove itself extremely prodigious in its infinite and mobile complexity as opposed to masculine writing which is perceived as governed by the phallus, a type of super-egoized machinery which is synonymous with the history of reasoning separating body from the text and ultimately rejecting female-sexed texts. As a result of this policy of exclusion, the true potential of many women goes unfulfilled. The reason behind this policy of exclusion is the most blamed à ¢Ã¢â€š ¬Ã… ¡dogma of castration which Cixous finds responsible for the sublation of the phalologocentric, a self-admiring and self-congratulatory tradition which censors the body and implicitly the speech, Freuds concept of castration anxiety. Irigary suggests the same type of Freudian reading through her mentioning of mens foraging for a social status and recognition: head/man/phallus/symbol of power. Freud argued that this castration anxiety stems from a fear of female genitalia, perceived by males at a subconscious level as the result of castration the female body understood subconsciously as lacking a phallus. Freud suggested that the mythical story of Medusa, in which people turn to stone when they look at the snake-covered head of the Gorgon, could be read as addressing this psychoanalytic fear. It follows that Cixous and Irigary argue, following many theorists, that this masculine view of women as lacking has broader social and political implications; our sexuality and the language in which we communicate are inextricably linked. To free one means freedom for the other. To write from ones body is to flee reality, to escape hierarchical bonds and thereby come closer to what Cixous calls joissance, which can be defined as a virtually metaphysical fulfilment of desire that goes far beyond [mere] satisfaction [It is a] fusion of the erotic, the mystical, and the political (Gilbert: xvii). Cixous definition of jouissance is that which operates outside of patriarchy, in the realm of the feminine Imaginary and is a crucial concept since it is the source of womens writing and of breaking the Law of the Father. à ¢Ã¢â€š ¬Ã… ¾The Laugh of the Medusa and This Sex Which Is Not One also draw on the writings of Ferdinand de Saussure and Jacques Lacan displaying an interest in connecting language, psyche and sexuality. Lacans theory develops the notion of the development of the (male) ego from Pre-Oedipal (non-linguistic) Imaginary to Symbolic via the castration complex which is both a sexual and linguistic model. The Imaginary is fashioned as a feminine space (connected to the body, the mother, the breast). The Symbolic is associated with the Law of the Father and is a condition of having acquired language and sexual difference. The current essays seem to reject the feminine Imaginary which is non-signifying or outside of language. In order to express her opposition, Cixous uses Doras case of aphonia which is considered to be the true à ¢Ã¢â€š ¬Ã… ¡mistress of the Signifier, replacing the phallus as the privileged Signifier from Lacans theory. Dora, the misunderstood hysterical woman, like Medusa, could be read as a mythological figure, examples of women who speak their body and threaten patriarchy. They have the capacity to continue to interrogate and ultimately to deconstruct the Law of the Father. Doras words coming to us in twisted form rebel against the master/author of her story giving access to immense resources of the unconscious, de-censoring body and speech. à ¢Ã¢â€š ¬Ã… ¾The Laugh of the Medusa, therefore, revises the Freudian model which defines woman as lack, once again alluding to the Law of the Father which is ruled by the fear of castration, and instead celebrates woman as excess. The fear of decapitation or castration should no longer be perceived as a threat at least for women. They always had the capacity to depropriate themselves. Woman is a whole that is made up of parts that in themselves are whole: She is indefinitely other in herself (Irigary: 204). Woman is also perceived as extremely complex and subtle in the geography of her pleasure which would be able to generate a connection between womens bodies and the making of meaning in a continuous play of signifier which would disrupt the symbolic former order of language. A similar standpoint is made by Cixous who states that this endless body has no end or parts, thus woman libido is cosmic (Cixous: 2051). Woman does not perform the regionalization on herself as masculine sexuality does, her Eros is not organized around any one sun, is not centralized, therefore woman language is not a solid opaque block, but a flow which displays meaning into a multiplicity of signifiers without contours or frontiers; woman is changeable and open, a cosmos tirelessly traversed by Eros (Cixous: 2051) which lacks repressive patterning and rejects logocentrism, or phallogocentrism. Thus it is suggested that the feminine writing is a way of signifying that calls into question or disrupts the Law of the Father because it will give access to women native strength and sexuality and un-coax conventions. Along with this rupture there comes a dislocation of language. In addition, womens writing is also described in terms of childbirth; a metaphor for the vast resources of feminine creativity. By extension, womens writing is described using imagery such as the mothers voice/body/milk: à ¢Ã¢â€š ¬Ã… ¾write in white ink (Cixous: 2045), therefore a desired return to the pre-Oedipal stage where binaries were absent. Drawing on the resources of the Imaginary, mining its depths, women are urged in both above-mentioned essays to invent another history, one which is outside of narratives of power, inequality and oppression, and which figures itself in our language and on our bodies. The upheaval of these transformations is made possible through the process of collapsing the binary oppositions in which à ¢Ã¢â€š ¬Ã… ¡woman has functioned as a negative term, always referring back to its opposite pair which annihilated its energy and causing woman to function within the discourse of man. Therefore a return to Pre-Oedipal stage is suggested, a return to a time before the creation of oppositional binaries prior to the imposition of the categories of male and female. This is the period associated with the mothers body. In this way, Cixous notion of feminine writing can be both feminine and non-essentialist, although this latter assertion is a matter of considerable debate amongst Cixous critics. Therefore the oppositions do not limit themselves to the traditional antagony male/female, but extend beyond it to a à ¢Ã¢â€š ¬Ã… ¡logic of the One and a logic of heterogenity and multiplicity which suggest that it is high time the phallocentric tradition be replaced by an in finite richness of individual subjectivities. The body entering the text disrupts the masculine economy of superimposed linearity: the feminine is the overflow of luminous torrents, a margin of excess eroticism and free-play not directly attributable to the fixed hierarchies of masculinity. Hierarchical structures are shaken and subjective differences are encouraged so that à ©criture fà ©minine could emerge as a way of overcoming the limits of Western logocentrism: à ¢Ã¢â€š ¬Ã… ¡Almost everything is yet to be written by women about feminity, sexuality, infinite and mobile complexity (Cixous: 2049). The new feminine language, which yet needs to be invented, would be able to collapse partitions, classes and code à ¢Ã¢â€š ¬Ã… ¡sweeping away syntax. At the end of the phallic era, women are envisaged as having two possible alternatives: they either give up any aspiration and become annihilated, or raise against their submissive and passive role to reach their full à ¢Ã¢â€š ¬Ã… ¡incandescence. Writing becomes therefore the main imperative for women. They are asked to think differently, to leave behind the psychoanalytic labels and laws of the signifier which would only alter the generative powers of feminine writing: In one another we will never be lacking (Cixous: 2056). Therefore writing is the passageway, entrance, exit, and dwelling of the other. For man this non-exclusion is seen as a threat, as intolerable. Feminine writing keeps alive the other, as love is not perceived in economic terms any longer.

Dworkins Belief Of Preferential Treatment :: essays research papers

Dworkin's Belief of Preferential Treatment For many years, preferential treatment has been used to try to make up for past wrong-doings to minorities. There have been many cases tried over racial discrimination, with verdicts of both innocent and guilty. Ronald Dworkin attempts to argue that preferential treatment is socially useful and at the same time does not violate people's rights. This is wrong for many reasons; here I shall illustrate how preferential treatment hinders racial equality, violates people's rights, and can lead to a lower opinion toward a particular race. Dworkin believes that continuing preferential treatment will decrease racial consciousness and the importance of race. This is the total opposite of what truly happens. If a person were to consider America's past, as an example, he would see how racially diverse people were. Now look around. Just walking across any given area, groups of people of the same race are seen walking together. Most people do not notice this, but very rarely are groups of ethnically diverse people seen. Although there are no longer any laws stating that there must be a separation between different races, people still practice it unconsciously. Dworkin states that the long-term goal of preferential treatment "is to reduce the degree to which American society is overall a racially conscious society (294)." Preferential treatment does nothing of the sort. It was used widely in the past and still exists in some areas today. It has not reduced racial consciousness, but increased it by making people think more about how many spaces are reserved for their particular race. Instead, people should think of what their chances are of getting something on account of their personal knowledge over someone else's, not even considering their race as a factor. This is evident in a black's point of view of getting into the medical school of the University of California at Davis. Sixteen places are set aside just for blacks and other minorities, no matter how low their test scores are. That way, minorities don't even have to worry about competing with whites for a position. This does not, in any way, reduce racial consciousness by setting two tracks for admission to medical school, one for the minorities, and one for the majority. Mr. Dworkin supports the idea that preferential treatment does not violate people's rights. His argument is weak here because he attempts to prove this by saying that if two things do not violate people's rights, then neither does a third. The two things that supposedly do not violate rights are the denial of someone to medical school because of their age and because their test

Gender in Shakespeares As You Like It :: Shakespeare As You Like It Essays

Gender in As You Like It One of the most intriguing aspects of the treatment of love in As You Like It concerns the issue of gender. And this issue, for obvious reasons, has generated a special interest in recent times. The principal reason for such a thematic concern in the play is the cross dressing and role playing. The central love interest between Rosalind and Orlando calls into question the conventional wisdom about men's and women's gender roles and challenges our preconceptions about these roles in courtship, erotic love, and beyond. At the heart of this courtship is a very complex ambiguity which it is difficult fully to appreciate without a production to refer to. But here we have a man (the actor) playing a woman (Rosalind), who has dressed herself up as a man (Ganymede), and who is pretending to be a woman (Rosalind) in the courtship game with Orlando. Even if, in modern times, Rosalind is not played by a young male actor, the theatrical irony is complex enough. The most obvious issue raised by the cross dressing is the relationship between gender roles and clothes (or outer appearance). For Rosalind passes herself off easily enough as a man and, in the process, acquires a certain freedom to move around, give advice, and associate as an equal among other men (this freedom gives her the power to initiate the courtship). Her disguise is, in that sense, much more significant than Celia's, for Celia remains female in her role as Aliena and is thus largely passive (her pseudonym meaning "Stranger" or "outsider" is an interesting one). The fact that Celia is largely passive in the Forest of Ardenne (especially in contrast to Rosalind) and has to wait for life to deliver a man to her rather than seeking one out, as Rosalind does, is an interesting and important difference between the two friends. These points raise some interesting issues. If becoming accepted as a man and getting the freedom to act that comes with that acceptance is simply a matter of presenting oneself as a man, then what do we say about all the enshrined natural differences we claim as the basis for our different treatment of men and women?

Personal Narrative- Living Life on the Edge :: Personal Perspective

Personal Narrative- Living Life on the Edge Heart racing, palms clammy, stuttering with nervousness. All things that usually don’t describe one’s favorite thing in the world, however in my case those are the common symptoms for my favorite way to relax in the world, adrenaline rushes. Anything that puts you so close to death you could touch it, but still hang on to a thread of life to pull yourself back up with. It sounds immature and irresponsible, I know, but don’t judge until you’ve tried, and I could never describe the rush and the complete whole, peaceful state of meditation adrenaline rushes put me in that makes all the danger in the world entirely worth it. It was late afternoon in early July and the most clear day ever conceived. I spent most of the day hiking on a mountain in North Carolina, surprisingly not sweating all that bad, but growing impatient of when â€Å"paradise† would place itself in front of me as promised. Every time I asked I got a clone answer â€Å"soon†. Alright soon but define soon, soon could mean different things right? Wrong! Right as the last breath of my question left my mouth it fell in front of me , Paradise. Well, the middle of nowhere to be exact, but paradise all the same. It was the side of the mountain where a long cliff jetted out. Being the little daredevil I am I had to see more. I climbed down off the side of the mountain on to the ledge and walked to the very edge. As I walked further out it narrowed to a one foot across point. I sat down and dangled my feet and where earth was below me there was this little hidden beach with crystal blue water. Not a single footprint in the white sa nd with a soft flowing waterfall of clear water and soft gray rocks strategically placed to make up a true paradise. It was the most spectacular sight ever. It was truly the closest thing to heaven I had ever seen. I have been told that nothing is perfect, well obviously whomever said that had never been here. As I sat there with my feet dangling the pit of my stomach dropped.

Ikea report Essay

Executive summary This report describes the importance of market research, the target market and market segmentation. How a business can use a situation analysis and SWOT to provide a direction for Ikea. This examines how types of customers and buyer behaviour will impact marketing strategies. Evaluates as a key marketing strategy for Ikea as a case study. Analyses marketing strategies can be used to achieve marketing objectives and describes some ethical and legal things that a business must manage and respond to while marketing. Business Overview Ikea is a well-known global brand with hundreds of stores across the world. In order to improve performance, it must assess its external and competitive environment. This will reveal the key opportunities it can take advantage of and the threats it must deal with. Ikea responds to both internal and external issues in a proactive and dynamic manner by using its strengths and reducing its weaknesses. Through this, Ikea is able to generate the strong growth it needs to retain a strong identity in the market. Ikea’s passion combines design, low prices, economical use of resources, and responsibility for people and the environment. The company’s products, processes and systems all demonstrate its environmental stance. For example, clever use of packaging and design means more items can fit into a crate, which means fewer delivery journeys. This in turn reduces Ikea’s carbon footprint. Ikea believes that there is no compromise between doing good business and being a go od business. It aims to go beyond profitability and reputation. Ikea is intent on becoming a leading example in developing a sustainable business. This will create a better everyday life for its customers. Market research When Ikea conducts market research it is important that the business first determines its information needs. The business should have some idea about the type of information it is looking for. It could vary from customer profiles or brand awareness through to attitudes towards certain new products. Once its information needs are established, the business can determine the most appropriate research method. This is primarily done by IKEA group although individual stores would use sales reports in order to  gather data about the types of customers and popular products that are particular to the area or store. The Target Market The target market is a group of customers for whom a particular product has been developed. The business hopes that these people will buy the product when it is made available in the marketplace. Some products appeal to all consumers, while others have limited appeal. A business needs to understand the nature of consumer markets. The three types of markets Ikea appeals to are Consumer, Mass and niche. The products in Ikea produce are universal to all and with their flat pack design they fall into the niche market. Ikea focuses on meeting the customer demands and satisfying their needs. Ikea’s main focus is that of the selling orientation. Market segmentation Market segmentation is the process of breaking down a total market into small markets It allows businesses to focus their efforts and resources on a section of the market. By focusing on a particular target group, It would consider the features that consumers of this target group would be looking for in a product, the appropriate promotional strategies to generate awareness of and sustain interest in the product, and the most suitable pricing policies and distribution channels. Market segmentation and product/service differentiation,Demographic segmentation, dividing consumers into groups based on selected demographics, so that different groups can be treated deferent Situation analysis and SWOT Situation analysis is the way in which a business can examine the current position within the market and provides them with direction for their marketing campaign. SWOT is the first stage of planning and looks at the Strengths, Weaknesses, Opportunities and Threats involved in a project or business venture. For example, one of Ikea’s key strengths is its strategic aim to use no more material than necessary in the production of each item. One particular table, the NORDEN table, uses knotty birch wood. The knots in this wood usually mean it is rejected by other retailers and manufacturers as unsuitable for use. However, IKEA has made the knots part of its design feature. Types of customers. psychographic segmentation, this is based on lifestyle and personality, values and interest, Ikea does not divide the store into sections but you have to walk through the whole store before you can exit, this is a strategy to sell more products. The types of customers vary from people, households, firms, educational institutions, government, clubs and societies, religious organisations. The customers that account for most of Ikea’s sale is the bold customer. Ikea is a business that is not aiming towards a purchase occasion but the usage rate of their product, being household items they aim for their products to last well and function to a good quality standard. Ikea has a good user loyalty with a wide range of buyers from the types of customers. Consumers see how affordable Ikea products are and how well they last, as long as they don’t mind putting the product together. The buying process would not be different from Ikea customers but the free yearly catalogue gives purchasers time to plan a trip to Ikea as the Ikea stores are not usually located conveniently due to the large floor space required to house their product. Ikea stores are not usually located outside the inner metropolitan area for this reason. There are psychological, sociocultural, economic and government reasons why people shop or don’t shop are Psychological segmentation Branding. Ikea is ranking 41 in the world’s most valuable brands. The brand name alone is worth 8 million. The brand image for Ikea stands for affordable, contemporary design and its flat pack product range that gives Ikea its identity. The brand name or logo essentially provides a message to the people of the quality and value associated with that product, when they see it they immediately form judgements on the quality, a strong brand name is essentially enhancing the relationship between a business and its customer. Marketing and strategies Product Ikea’s products are tangible, Product matters because it is the reason that customers go to Ikea in the first place. Ikea has the market in flat pack furniture and the unique design attracts customers and meets their needs, this product could include the prestige of owning the product which would also relate to psychological factors. Place Place matters because it is how the customers access the product. The Ikea experience is more than just products, it is a retail concept laid out in such a way that families, singles, couples etc. can enjoy shopping for furniture. A day at Ikea has been described as more of an outing than a shopping trip. Price Price matters because it is at the heart of the Ikea concept. Flat pack furniture cannot compete on price with upmarket, fully assembled pieces, so it is essential that Ikea continues to keep its prices below the competition. Price including pricing methods, market and competition based, Competition based pricing is the commonly used pricing strategy. Promotion Promotion is the most public aspect of marketing and it matters because it helps to drive customers into the stores in order to buy furniture. Ethical and legal. Ikea is recognised as a business that is both legally and ethically a responsible business that looks beyond profit and develops a positive workforce with these practices, advertising is very powerful in developing the wrong or wright idea and misleading advertising is bad ethics. Developing products in 3rd world country is considered unethical because they get payed well below minimum wage. Ikea produces environmentally responsible products, the flat pack design would be argued that it minimizes wastage and the cardboard would be environmentally friendly. The role of consumer law deals with Deceptive and misleading advertising which could be false information about products features and content, false special offers which don’t exist and  overstating the benefits that a product will provide to the consumer. Price discrimination, giving preference to some retail stores by providing them with lower prices than is offered to the competitors of those retailers. The competitor and consumer act aims to discourage the price discrimination in the business environment. Implied conditions and warranties is a great way for a business to ensure the product will last at least the warrantee time, this attracts customers and the consumer expects the business to fulfill their legal obligation to provide a refund or replacement or the product if there is a manufacturing problem within the warranted date, regardless the business by law. Resale price maintenance, this aims to balance the profit maximization of a business, Ikea ensures that the quality of a product in one country doesn’t differ from another. A manufacturer cannot refuse to sell the goods to a retailor if the retailor intends to sell the product for below the recommended price.

Philosophy of life Essay

Unit 1: The nature of values – These Quotes and information are good to use when discussing values in any essay Values as ‘principles and fundamental convictions’ are abstractions until they are applied in the contexts of daily life. Values are made real or ‘realised’ when their meaning is expressed through choices made and behaviours acted out. Values are the priorities individuals and society attach to certain beliefs, experiences, and objects in deciding how they shall live and what they shall treasure. (Hill, 2004) principles and fundamental convictions which act as general guides to behaviour, the standards by which particular actions are judged as good or desirable. (Halstead, Taylor and Taylor, 2000) Unit 1: The nature of values – These Quotes and information are good to use when discussing values in any essay Values as ‘principles and fundamental convictions’ are abstractions until they are applied in the contexts of daily life. Values are made real or ‘realised’ when their meaning is expressed through choices made and behaviours acted out. Values are the priorities individuals and society attach to certain beliefs, experiences, and objects in deciding how they shall live and what they shall treasure. (Hill, 2004) principles and fundamental convictions which act as general guides to behaviour, the standards by which particular actions are judged as good or desirable. (Halstead, Taylor and Taylor, 2000) Unit 1: The nature of values – These Quotes and information are good to use when discussing values in any essay Values as ‘principles and fundamental convictions’ are abstractions until they are applied in the contexts of daily life. Values are made real or ‘realised’ when their meaning is expressed through choices made and behaviours acted out. Values are the priorities individuals and society attach to certain beliefs, experiences, and objects in deciding how they shall live and what they shall treasure. (Hill, 2004) principles and fundamental convictions which act as general guides to behaviour, the standards by which particular actions are judged as good or desirable. (Halstead, Taylor and Taylor, 2000).

Moral And Ethical Considerations Health And Social Care Essay

The end of utilizing automatons in medical specialty is to supply improved diagnostic capablenesss, a less aggressive and a more comfy experience for the patient, and the ability to make smaller and more accurate intercessions. A Automatons are presently used for prostate surgery, hysterectomies, the remotion of fibroids, joint replacings, open-heart surgery and kidney surgeries. They can be used along with MRIs to supply organ biopsies. While the physician can see images of the patient and command the automaton through a computing machine, he does non necessitate to be in the room, or even at the same location as the patient. A This means that a physician can run on a patient who is far off without either of them holding to go. It besides provides a better work atmosphere by cut downing strain and weariness. Surgeries that last for hours can do even the best sawboness to see manus failing and shudders, while automatons are more stable and drum sander. Dr. D'Ovidio has extended experience in thoracic and esophageal malignant neoplastic disease, reflux and achalasia instances. Embracing the most advanced engineering, he has been trained to execute robotic thoracic surgery. Although you might visualise bantam small automatons repairing jobs inside your organic structure, Dr. D'Ovidio explains it ‘s â€Å" non like a automaton is making surgery and I ‘m holding java in a saloon. † ( hypertext transfer protocol: //www.columbiasurgery.net/tag/robotic-surgery/ ) The sawbones sits at a console to run a mechanical arm that has tools loaded on to it. In add-on to the fact that the sawbones can sit at easiness, another advantage is alleviating the weariness of holding to keep instruments for an drawn-out period of clip. The automatons use well greater optics to present 3-dimensional vision. In truth, robotic surgery is 3D. It has two â€Å" eyes † alternatively of merely 1. This gives a much better position. Besides, the automatons have articulations that articulate the tool in all waies. For illustration, like holding an arm with a carpus, as opposed to a laparoscope, where the arm is stiff with no wrist motion. â€Å" Although it ‘s fundamentally the same process as unfastened or laparoscopic surgery, you have much more refined action, † Dr. D'Ovidio says, â€Å" and achieve greater preciseness, less mistake, and less possible hemorrhage. That ‘s a benefit to the patient. † ( hypertext transfer protocol: //www.columbiasurgery.net/tag/robotic-surgery ) Marjorie Paulson, 75, lives in Long Island. Mrs. Paulson was thrilled to larn about Dr. D'Ovidio ‘s automaton and flew into the metropolis for surgery on February 28, 2012. Her process was a great campaigner for the robotic attack. Equally good as her hiatal hernia fix, due to the presence of esophageal shortening, Mrs. Paulson required a Collis gastroplasty to widen the gorge and easiness tenseness on the anti-reflux Nissen fundoplication process. She went home the following twenty-four hours, has had no hurting or any other symptoms, and feels superb. The district attorney Vinci surgical system is a somewhat invasive new attack that uses cutting edge robotic engineering. The district attorney Vinci Surgical System takes gynaecological surgery to new statures by leting highly precise motions, legerity and control through minimum surgical gaps and strong 3D vision and magnification. Marginally aggressive roboticA prostatectomy and roboticA hysterectomy intervention options now offer the potency for first-class post-operative map and malignant neoplastic disease direction results.A Quickly going the global intervention pick for prostate state of affairss, the district attorney Vinci Robot is besides puting a new benchmark with the district attorney Vinci hysterectomy, for the broad scope of uterine conditions that need surgery. This criterion is accredited to the improved benefits of truth and magnification at the operative site, every bit good as a shorter timeline for recovery, decreased hurting, fewer troubles, reduced scarring an d lower hazard of infection. With the sawbones steering robotic weaponries from a sing console some pess off from the patient. As an option to doing a big scratch, the automaton ‘s tools and camera are inserted through four little holes in the patient ‘s thorax. The automaton used in the patterns, the Intuitive Surgical district attorney Vinci System, has Food and Drug Administration consent for a figure of clinical tests in bosom surgery. Initial consequences show that on norm, patients stayed in the infirmary two to four yearss less and returned to work 50 per centum quicker than those holding the unfastened process. The district attorney Vinci Surgical System, made by Intuitive Surgical, Inc. of Sunnyvale, Calif. , is freed to execute surgery under the counsel of a sawbones. As of May 2012, more than 1,840 da Vinci Systems are installed in over 1,450 infirmaries worldwide. ( hypertext transfer protocol: //allaboutroboticsurgery.com/surgicalrobots.html ) The district attorney Vinci Si double console besides permits sawboness from different Fieldss to work together on the same patient. For illustration, a patient undergoing gynaecological and urological processs can be robotically operated on at similar times, allowing both sawboness to work together and decreasing the hazards of jobs for the patient. The most apparent advantage of the double console is the capacity to develop new robotics sawboness. Alternatively of the mentoring sawbones and mentoree swapping topographic points back and Forth throughout the surgery, both can now work in tandem. The productiveness of holding two sawboness working at the same clip could easy accelerate the acquisition curve as both sawboness are seeing the same anatomy and sharing the same tools, merely like the larning procedure in unfastened surgery. The accelerated acquisition curve for the sawboness means a batch more instances can be done, allowing even more patients to gain from robotics surgery. Hospital corsets can be decreased by about half, cut downing infirmary cost by about 33 % . These fewer yearss in the intensive attention unit are a consequence of less hurting and quicker recovery. ( hypertext transfer protocol: //allaboutroboticsurgery.com/surgicalrobots.html ) Though the size of the mechanism is still non little plenty for bosom processs in kids, the minimally aggressive nature of district attorney Vinci does non go forth a big surgical cicatrix and still has some limited applications in kids for the clip being. Furthermore, harmonizing to Intuitive Surgical, merely 80,000 out of 230,000 new instances of prostate malignant neoplastic disease undergo surgery because of the high hazard invasive surgery carries, connoting that more people may undergo surgery with this germinating engineering. ( hypertext transfer protocol: //allaboutroboticsurgery.com/surgicalrobots.html ) The chief disadvantages to this engineering are the steep acquisition curve and high cost of th e device. Though Intuitive Surgical provides a preparation plan, it took sawboness about 12-18 patients before they felt secure executing the technique. The big floor-mounted patient-side cart confines the helper sawbones ‘s attack to the patient. Though, there are besides many who are unable to entree the district attorney Vinci based on the steep monetary value. In a paper published by The American Journal of Surgery, 75 % of sawboness claimed that they felt financially limited by any system that cost more than $ 500,000. As of now, surgery with the district attorney Vinci Surgical System takes 40-50 proceedingss longer, but the FDA considered this a learning curve variable and expects clip to better with more usage of the system. ( hypertext transfer protocol: //allaboutroboticsurgery.com/surgicalrobots.html ) Acrobot Precision Surgical Systems mission is bettering the velocity, truth and duplicability of joint replacing, guaranting maximal benefit for the sawbones and the patient Acrobot provides preciseness surgical systems for computer-assisted 3D planning, surgical pilotage and surgeon-controlled robotic surgery. ( hypertext transfer protocol: //allaboutroboticsurgery.com/surgicalrobots.html ) In order to better clinical results, addendum sawbones accomplishments, enable bone preservation and increase productiveness. When joint replacing cogwheels are implanted exactly and successfully, the patient ‘s post-operative recovery clip can be cut and hurting and troubles can be minimized, which should so take to improved quality of life for the patient. With the enlargement of accoutrement engineerings, such as visual image systems, retractors, and stabilizers, every bit good as other methods of vascular canulation and cardiorespiratory beltway ( CPB ) , such as peripheral CPB and endoaortic balloon engineering, many past restrictions have been conquered. Many physicians have shown promising consequences utilizing a mini-sternotomy, parasternal scratch, and mini-thoracotomy for complex cardiac processs, including coronary arteria beltway grafting ( CABG ) , mitral and aortal valve surgery, and atrial septal defect ( ASD ) closing. ( hypertext transfer protocol: //ats.ctsnetjournals.org/cgi/content/full/77/4/1328 ) The following measure has been the creative activity of thoracoscopic surgery utilizing computerized telemicromanipulation. Using a surgical robotic system, sawboness can work little endoscopic instruments, which are put in through ports one centimetre in size, recognizing many of the proficient operations merely anteceden tly possible with unfastened surgery. Supporters of minimally aggressive techniques have assumed that by diminishing the scratch size and entire operative injury, it may be possible to diminish postoperative hurting and better quality of life, rendering into a rapid recovery and the ability to go on preoperative activities, such as work. While several surveies of robotically supported cardiac surgery have reported hurts and deceases, merely one survey has addressed hurting and quality of life, comparing patients who underwent larboard entree techniques with patients who underwent a sternotomy. Supporters of robotic engineering for atrial septate defect closing have stated, based on subjective experience, that postoperative hurting is reduced and quality of life is improved in patients undergoing surgery with robotic techniques as opposed to conservative attacks, such as a sternotomy or thoracotomy. Robotically aided thoracoscopic atrial septate defect fix resulted in first-class quality of life after 30 yearss. Quality of life result steps were significantly superior in the robotic group as compared to patients who underwent surgery utilizing nonthoracoscopic techniques, such as sternotomy and mini-thoracotomy. ( http: //onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.02038.x/full ) A robotic attack prevents the injury of a sternotomy or thoracotomy, which is an of import concern to many patients. Patients who endured a robotic attack returned to work earlier than patients who endured a mini-thoracotomy or sternotomy. Along with better-quality patient attention, another end of doing medical robotics conventional is to cut down on medical costs. But, this is non ever the instance. Some robotic surgery systems cost more than $ 1 million to get and $ 100,000 a twelvemonth or more to keep. A This means that infirmaries need to measure the cost of the machine vs. the cost of conventional attention. If robotic surgery cuts down on the hurting and healing clip, so money is saved because the figure of yearss the patient stays in the infirmary is reduced. There is besides a decrease in the sum of employees needed in the operating room during surgery. In contrast, monolithic preparation clip is required for physicians to larn to plan and command the machines. Another fright is that there are really few shapers of medical robotics. With small competition, the few shapers that exist can put their ain monetary values. Medical robotics are still new, and there is much more work to be done. And expensive, which can do it unaffordable for many infirmaries and health-care centres. A There are besides still issues with inaction. This means the clip oversight between the blink of an eyes when the physician shifts the controls and when the automaton responds. Plus, there is still a hazard for human mistake if the physician falsely plans the automaton before surgery. Computer plans can non modify their class during surgery, while a human sawbones can do needful corrections. As sawboness become more acquainted with utilizing automatons for surgery, and as more companies provide medical automatons, thereA will come a twenty-four hours when automatons are used in about every infirmary. Yet, this is still far off in the hereafter. One of the defects of most robotic surgical systems today is the absence of the esthesis of touch for the sawbones. Execution of tactile feedback into robotic surgical systems can transform the physician ‘s user experience by leting designation of altered tissue constructions, forestalling tissue harm, sing right sutura arrangement and dwindling undertaking completion clip. The increasing trouble of recent surgical engineering will necessitate more rigorous guidelines for concern and pattern similar to the subject used in air power. Using a surgical automaton suggests that the sawbones is no longer in direct physical or ocular contact with the patient. The sawbones non merely operates through computing machine bids but there is besides a significant distance to the helpers go toing the operation tabular array. Unfortunately, the current systems lack an acceptable manner to pass on between the operator and the helpers. As with many new technological developments, communicating might look to be the Achilles ‘ heel of robotic surgery. More suited equipment of communicating and more steadfast subject in followup of the orders from the primary responsible individual, the sawbones, will be critical for a safe and successful process. Telemedicine makes cross-border intervention possible. Cross-border attention should non alter the usual medical moralss but makes intervention likely of patients in countries the physician can non make in individual. Under served parts and states could be assisted. But the engineering could besides rise the resettlement of physicians from hapless to rich countries and states. Besides, the security of the transmitted information between the sawbones and the distant automaton is at interest. That informations should be treated the same manner as written medical records. Mistakes of the robotic system will go on more often with the increasing usage of the machine. Fortunately, it appeared that less than five per centum of device mistakes lead to patient troubles. Additionally, the sum of unfastened alterations due to malfunctions decreased from 94 % in 2003 to 16 % in 2007. ( http: //onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.02038.x/full ) Even though automatons seem to move freely, all of their motions and actions are controlled by the sawbones and as such do non differ from any other surgical equipment. Still, as with any complicated system, safety safeguards will be more important than with the usage of simple instruments. Local every bit good as national and international guidelines will necessitate to be established to turn to specific issues. In 2007, the first policy guidelines for the robot-assisted prostatectomy were suggested in an column by Valvo et Al. ( http: //onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.02038.x/full ) The Society of American Gastrointestinal and Endoscopic Surgeons and the Minimally Invasive Robotic Association thought that guidelines for the usage of robotics were missing. To get the better of this spread, they issued a consensus statement on robotic surgery including guidelines for preparation and credentialing. The World Medical Association ( WMA ) made a statement on the moralss of telemedicine on their last meeting in Copenhagen. Included are codifications for the patient-physician relationship and confidentiality, the duties of the doctor and the quality of attention. The World Medical Association is assuring the development of national statute law and international understandings on telemedicine. Robotic surgery is besides known as cyber surgery. The elaborateness of judicial proceeding associated with robotic surgery is complex. In add-on to being able to action doctors and infirmaries, patients who endure an unpleasant result after robotic surgery will hold the possible to action the robotic maker and the telecommunications company. Nevertheless, robotic surgery judicial proceeding will affect Torahs that are by and large unaccustomed to healthcare suppliers. There are non excessively many instances on robotic surgery malpractice, a batch of the instances have been hard to turn out whether it was the sawbones or the mistake of the shapers that made the automaton. Over the following few old ages, robotic or distant surgery will be in pattern on a broader graduated table and cases will finally follow.

Pediatric Nursing Shortage Essay

The Society of Pediatric Nurses (SPN) has been instrumental in advocating for high quality, culturally sensitive, and comprehensive care for children and families. The healthcare needs of pediatric patients present unique challenges due to different developmental stages, limited communication skills, and differences in epidemiology and approaches to treatment as compared to adults. Nurse staffing is a focus of major concern because of the impact of staffing patterns on patient safety and quality of care. The advent of managed care, shortened hospital stays, and public reporting of quality measures demand that healthcare organizations objectively define and assess the quality of care delivered to children and families. Registered Nurses are the primary caregivers within the healthcare setting and are the essential link in assisting patients and families with navigating and humanizing a highly technical and impersonal healthcare system. An organization’s commitment to high quali ty pediatric care is dependent upon appropriate staffing levels with adequately prepared nurses and the implementation of collaborative, evidence-based practice (Schwalenstocker, Bisarya, Lau, & Adebimpe, 2007). In 2007, members of the Public Policy Committee developed the Safe Staffing Position Statement. This document outlined recommendations for safe and effective nursing care for children and their families. The position statement was recently updated and is intended to serve as the framework to assist organizations providing care to children in the implementation of evidenced based staffing plans to promote high-quality care. It is imperative that schools of nursing, healthcare institutions and pediatric nurses utilize this document as a resource to ensure that appropriate education, training, resources and effective staffing plans are provided to ensure the provision of safe, quality, customer focused care to pediatric patients and their families. Problem Statement Following a Congressional request in 1993 for the Institute of Medicine (IOM) to study the adequacy of nurse staffing in hospitals and nursing homes, a 1996 IOM report recognized the importance of determining the appropriate nurse-patient ratios and distribution of skills to ensure patients receive quality care. A September 1999 IOM report first called the public’s attention to the problem of increased patient morbidity and mortality related to errors occurring within healthcare delivery systems. Since that time there has been a growing emphasis on patient safety, process improvement and the potential effects of adequate staffing. Rationale and Supporting Information Research has continued to show the association between nursing staffing and improved patient outcomes (Aiken, et al, 2010; Kane, et al, 2007; Needleman, et al, 2006; Stanton, 2004; American Organization of Nurse Executives, 2003; Aiken, et al, 2002). In 2007 the Child Health Corporation of America is association with the National Association of Children’s Hospitals and Related Institutions (NACHRI) and Medical Management Planning/BENCHmarking Effort for Networking Children’s Hospitals found increased nurse staffing was associated with improved patient/family experience with care and a reduced incidence of adverse outcomes. NACHRI also reported that The Joint Commission found staffing levels had been a critical factor in 20 percent of sentinel events occurring over a ten year period from 19952005 (Schwalenstocker, Bisarya, Lau & Adebimpe, 2007). Stratton (2008) found a reduction in the rate of pediatric central line blood stream infections with an increase in nursing sta ffing hours. Research conducted by Mark, Harless and Berman (2007) showed a statistically significant reduction in postoperative cardiopulmonary complications, pneumonia and infections in the pediatric population with increased RN staffing. In addition, nurse staffing levels have also been found to be a critical determinant of nurse job satisfaction (American Organization of Nurse Executives, 2003). During the 108th Session of Congress (2003-2004), The Registered Nurse Safe Staffing Act was first introduced. The intent of the act is to hold hospitals accountable for the implementation of valid and reliable nurse staffing plans, taking into consideration each hospital unit’s unique needs and strengths. The Registered Nurse Safe Staffing Act was reintroduced in the 110th Congress (2007-2008) and further refined and reintroduced on June 15, 2010 under S.3491/H.R.5527 during the 111th Congress (American Nurses Association, 2010). The Society of Pediatric Nurses (SPN) believes the following additional factors are of critical importance regarding safe staffing for pediatric patients: †¢ There are unique challenges with caring for children. These challenges include: o Infants and young children are dependent upon adult caregivers and require closer supervision. o Many children have not yet acquired the communication skills to warn clinicians about a potential mistake or verbalize possible adverse effects about their care. Medication administration is much more complex since weight based dosing is required o for most medications (Kaushal, et al, 2001). The acuity and intensity of nursing resources required to care for children have been growing steadily (Monsen & Finley, 2007; NACHRI, 2003). Of the 14.1 million children in the US living in poverty, 1 in 10 lack health care coverage (Children’s Defense Fund, 2010). Childhood poverty contributes to deficits in primary and preventative health care and results in increased healthcare issues and higher acuity for these children (Children’s Defense Fund, 2002). Pediatric nurses practice in many settings including hospitals, schools, homes, clinics, long term care facilities, and public health centers. The multitude of settings and the wide range of resources available in each setting greatly affect the type and number of nursing staff required to care for any given patient population. The level of experience of nursing staff, unit layout, and level of ancillary support must be considered when establishing the staffing needs and assignment plan for any given unit (Institute of Medicine, 2010; American Nurses Association, 2007). Society of Pediatric Nurses Position/Recommendations SPN believes that all children and their families should receive safe, high quality, culturally sensitive, family-centered care in an environment that supports the development of the child and promotes excellence in nursing care. As an advocate for patients, families, and the pediatric nursing profession, SPN endorses the following recommendations: 1. Staffing is a complex issue composed of multiple variables (American Organization of Nurse Executives, 2003). No single published ratio for nursing staffing is automatically applicable in all settings where children receive care. Published recommendations for staffing ratios must be carefully evaluated for the particular pediatric setting since these ratios may inadvertently minimize the complexity and multitude of issues that must be considered in the care of pediatric patients and their families. 2. The professional registered nurse must be considered an essential member of the team providing care for children and their families; staffing plans must reflect this vital role (American Nurses Credentialing Center, 2003). 3. Healthcare institutions should develop valid and reliable staffing plans (American Nurses Association, 2010) and patient assignments should promote developmentally appropriate, high quality care for children and families. Nursing leadership, registered nurses and other designated nursing staff should be involved in the development of staffing plans and proper preparation of staff for the patient populations cared for within the facility (Joint Commission, 2010). 4. While the specific details of these staffing plans will vary with individual patient needs and facility resources, SPN believes the following factors should be considered in all staffing situations: Number and acuity of the patient population. a. Assessment of patient needs including special developmental, physiological, psychosocial, and learning needs of children and their families. b. Availability of specialized pediatric equipment and supplies to provide the necessary care and the availability of other support services such as respiratory care, child life, social services, and spiritual care (American Academy of Pediatrics, 2006, 2004a, 2004b, 1998). c. Level of education, competency, and the extent of experience and specialized pediatric training of available staff. d. Family involvement and/or the family’s special needs related to meeting the healthcare needs of the child (American Academy of Pediatrics, 2006; Lewandowski & Tessler, 2003). e. Comparable pediatric staffing benchmark data and/or staffing guidelines from other pediatric focused professional organizations should be integrated into developing staffing plans if at all possible (National Association of Neonatal Nurses 2008; American Nurses Association, 2008; American Academy of Pediatrics 2006, 2004a, 2004b, 1998; NACHRI, 2003). 5. Nurses caring for pediatric patients must have appropriate education and experience to demonstrate competency in the care of this highly specialized patient population. The core concepts as cited in the following sources should be included in education and training: Pediatric Nursing: Scope and Standards of Pediatric Nursing Practice (American Nurses Association, 2008) Position Statement on Family Centered Care Content in the Nursing Education Curriculum (Society of Pediatric Nurses, 2008) Position Statement on Child Health Content in the Undergraduate Curriculum (Society of Pediatric Nurses, 2007) Core Curriculum for the Nursing Care of Children and Their Families (Broome & Rollins, 1999) Standards and Guidelines for Pre-Licensure and Early Professional Education for the Nursing Care of Children and Their Families (Woodring, 1998). 6. Organizations and nursing staff providing care for pediatric patients should commit to ongoing maintenance of nursing staff’s clinical competency through continuing education that ensures a current knowledge base of issues and trends in pediatric care delivery. 7. Organizations should work to establish practice environments characterized by open communication, teamwork, and effective collaborative problem solving to address nurse staffing issues and ensure safe, effective care for children and families. 8. Nurses are encouraged to assume professional accountability for their own practice. Nurses have accountability for the following: Being an advocate for the role of the registered professional nurse Being knowledgeable of state practice acts Being knowledgeable of the mechanisms available to address potential staffing issues References Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., Spetz, J. & Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health Services Research, 45(4), 904-921. Aiken L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987-1993. American Academy of Pediatrics (2006). Child life services. Pediatrics, 118(4); 1757-1763. American Academy of Pediatrics (2004b). Levels of neonatal care. Pediatrics 114(5); 1342-1347. American Academy of Pediatrics (2004a). Guidelines and levels of care for pediatric intensive care units. Pediatrics 114(4); 1114-1125. American Academy of Pediatrics (1998). Facilities and equipment for the care of pediatric patients in a community hospital. Pediatrics 101(6); 1089-1090. American Nurses Association. (2010). Safe staffing saves lives. Federal legislation: Registered nurse safe staffing act. Retrieved on-line February 13, 2011. http://www.safestaffingsaveslives.org/whatisANAdoing/federallegislation.aspx?css=print American Nurses Association (2008). Pediatric nursing: Scope and standards of practice. Washington DC: Author. American Nurses Association. (2007). Acute care staffing. Nursing’s legislative and regulatory initiatives for the 110th Congress: Appropriate staffing. Retrieved on-line: February 13, 2011. http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/Federal/legis/AcuteCare.aspx. American Nurses Credentialing Center. (2003). The magnet recognition program for excellence in nursing service health care organization, instructions and application process. Pub# MAGMAN03. Washington, DC: Author. American Organization of Nurse Executives (2003). AONE policy statement on mandated staffing ratios. Retrieved on-line: January 21, 20 11. http://www.aone.org/aone/advocacy/ps_ratios.html. Broome, M. & Rollins, J. (Eds.). (1999). Core curriculum for the nursing care of children and their families. Pittman, NJ: Jannetti Publications. Children’s Defense Fund. (2010). The state of America’s children 2010. Retrieved on line February 13, 2011. http://www.childrensdefense.org/child-research-data-publications/data/state-of-americas-children2010-report.html. Children’s Defense Fund. (2002). Basic facts on poverty. Child Poverty FAQs. Washington DC: Author. Institute of Medicine. (2010). The future of nursing: leading change, advancing health. Report brief: 2010. Washington DC: Author. Institute of Medicine. (1999). To err is human: Building a safer health care system. Washington, DC: Author. Joint Commission. (2010). Joint commission accreditation resources: Accreditation manager plus. Retrieved on-line: February 21, 2011. http://qvcsql01/JCRAMP/Frame.aspx. Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., Wilt, T. J. (2007). The association of registered nurse staffing levels and patient outcomes. Systematic review and meta-analysis. Medical Care, 45(12): 1195-1204. Kaushal, R., Bates, D.W., Landrigan, C., McKenna, K. J., Clapp, M. D., Federico, F., Goldman, D. A. (2001). Medication errors and adverse drug events in pediatric inpatients. Journal of the American Medical Association, 285(16), 2114-2120. Lewandowski, L. A. & Tessler, M. D. (Eds.). (2003). Family-centered care: Putting it into action: The SPN/ANA guide to family-centered care. Washington DC: American Nurses Publishing. Mark, B. A., Harless, D. W., Berman, W. F. (2007). Nurse staffing and adverse events in hospitalized children. Policy, Politics & Nursing Practice, 8(2): 83-92. Monsen, R. B., Finley, S. (2007). Shortage of nurses and child health. Journal of Pediatric Nursing, 22(3), 231-232). National Association of Children’s Hospitals and Related Institution s. (2003). Clinical practices service program: Benchmark data. Available from www.childrenshospitals.net/nachri. National Association of Neonatal Nurses (2008). Minimum RN staffing in NICU’s. Retrieved online February 11, 2011. http://www.nann.org/pdf/08_3009_rev.pdf. Needleman, J., Buerhaus, P. I., Stewart, M., Zelevinsky, K., Soeren, M. (2006). Nurse staffing in hospitals: Is there a business case for quality? Health Affairs, 25(1): 204-211. Schwalenstocker, E., Bisarya, H., Lau, S. & Adebimpe, O. (2007). Nursing-sensitive indicators for children’s hospital care quality: Indicators are essential, but further testing is needed for use in comparing hospital performance. A white paper prepared by the Pediatric Data Quality Systems (PediQS) Collaborative. September 2007. Retrieved on line: February 8, 2011: http://www.childrenshospitals.net/AM/Template.cfm?Section=Site_Map3&Template=/CM/ContentDisp lay.cfm&ContentID=29730. Society of Pediatric Nurses. (2008). Position st atement on family centered care content in the nursing education curriculum. Retrieved on-line: February 21, 2011. http://www.pedsnurses.org/component/option,com_docman/Itemid,222/task,doc_view/gid,193/